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Clinical Practice Guidelines/ABG sampling

Written by Ramaz Mitaishvili

Wednesday, 09 May 2007

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Clinical Practice Guidelines/ABG sampling
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You should hold syringe little bit differently for ABG. Pretty much like a
dart with angle 45 degrees.
Palpate area carefully. This is only your landmark to penetrate the skin in
going no where.
Syringe is ready to be inserted and put your finger on right place, and
roll back on half way this finger and now you can insert needle into the
skin. You should watch blood pulsating back into the syringe. When
blood return observed, hold needle very steadily, and either allow the
syringe barrel to fill or aspirate to pre-determined
amount. Remove needle quickly and apply firm pressure with gauze pad for five full
minutes (or longer if the patient is on anticoagulant therapy or is thrombocytopenic double this time). Now, insert needle straight into
the cube, than push down on the plunger to expel excessive air. Now,
you can remove cube and needle as one and attach black cap to the tip of
syringe. Gently mix the specimen by rolling it between your palms
Place the specimen on ice and transport to lab immediately. Last thing to
do: Put needle with cube in sharp container.
NOTE: If needle comes out of the artery during specimen aspiration, withdraw
needle, hold pressure, and start over.
If no blood is returned, slowly and carefully withdraw needle to re-enter artery.
If no blood return after first attempt, withdraw needle to point just below
skin surface, change direction and descend needle again.
And finally, if unsuccessful after two attempts, withdraw needle completely and
carry out post-puncture care.
Complications and How to Avoid
In general, an arterial puncture is an innocuous procedure, but
occasionally complications may occur. Awareness of the types of
complications and their contributory factors will help us to
minimize their occurrence.
• Pain
• Bruising
• Compression Neuropathy
• Aneurysm
• Spasms
• A.V. Fistula
• Mercury Embolism
Most series who have prospectively evaluated complications of arterial
puncture have come to the same conclusion. The procedure is safe, the
occurrence of serious complications are rare and most of the complications
are minor and temporary.
Pain
Pain during and following the procedure is a frequent complaint and is
reported to occur in 10% of the patient population. When systemically
looked for, tenderness at the puncture site was observed in 15% of
patients. You can minimize the pain by using thin needles and by the
use of local anaesthetic.
However, the local anaesthetic is ineffective in preventing late
symptoms. Sometimes the pain is felt proximal or distal to the puncture
site and this type of pain could be secondary to arterial spasm. In most
cases the discomfort following an arterial puncture is temporary and minor.
Bruising
Bruising is the most frequently observed complication occurring at
30% of puncture sites. In most, it is mild but in some you could
encounter large bruises. The bruising is more common at the radial
site. The brachial and femoral arteries lie deep, and this may account
for less frequently observed bruising at these sites.
A hematoma can occur at the puncture site in patients on anticoagulation. Serious retro peritoneal hemorrhage has been reported. The hematoma
formation in anticubital fossa is tolerated poorly and can result in
median nerve compression and ischemic changes secondary to
compression of the artery.
Compression Neuropathy
Compression neuropathy secondary to hematoma occurs at the cubital
fossa and the inguinal region. The facia that holds the neurovascular
bundle is tight and any extravasations of blood is tolerated poorly.
In the anticubital fossa the brachial artery and the median nerve pass
underneath the bicepital aponeurosis. This facia is unyielding and any
hematoma formation results in compression of the median nerve and
brachial artery. If the faciotomy is not performed, it could
eventuate into Volkmann's contracture.
Aneurysm
Aneurysm of the punctured vessel has been reported. This occurs with
repeated punctures. Fortunately this complication is rare.
Spasm
Spasms can temporarily decrease the pulse and cause pain.
Occasionally the vessel can occlude secondary to thrombosis.
Rarely has perivascular fibrosis and occlusion of the vessel been
noted. The collateral arch with ulnar artery fortunately prevents
any serious ischemic changes.
A.V. Fistula
Iatrogenic arteriovenous fistula has been reported rarely in patients who
have hand multiple arterial punctures. This complication is rare.
Mercury Embolism
Mercury embolism has been reported in the days when mercury was used
as an aerobic seal and mixing agent. This complication does not occur any
more.
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Last Updated ( Thursday, 21 June 2007 )